上肢远端透析建立自体动静脉瘘的治疗体会

Distal upper limb autologous arteriovenous fistula for hemodialysis

目的回顾性分析手术行上肢远端自体动静脉瘘建立血液透析通路的方法及处理动静脉瘘闭塞的治疗体会。方法总结2007年8月-2011年3月施行首次自体动静脉瘘术214例及处理动静脉瘘闭塞22例患者的临床资料，比较成功率及远期通畅率。结果214例首次自体动静脉瘘术，取鼻烟窝处头静脉-桡动脉侧侧吻合168例，腕关节近端头静脉-桡动脉端侧吻合46例，成功203例（94．8％），失败11例（5．2％），患肢水肿82例，无窃血综合征及心衰发生，1年通畅率为95．2％，2年通畅率为91．3％。处理动静脉瘘闭塞22例，包括术后急性闭塞取栓再通8例，吻合口狭窄血栓形成行取栓加球囊扩张再通8例、失败1例，慢性闭塞后近端再次吻合5例。结论上肢远端自体动静脉瘘术，以“鼻烟窝”处动静脉造瘘为首选方法，积极处理原有动静脉瘘的闭塞问题，往往可以延长患者自身血管的使用时间，提高生活质量。

Objective Retrospective analysis of experience of distal upper limb autologous arteriovenous fistula for hemodialysis access and treatment of arteriovenous fistula occlusion was conducted. Methods To summarize the clinical data of 214 cases of initial autologous arteriovenous fistula and 22 cases of treatment of arteriovenous fis- tula occlusion were carried out from Aug. 2007 to Mar. 2011, comparing the success rate and long-term patency rate. Results Two hundred and fourteen cases of initial autologous arteriovenous fistula, in which 168 cases were cephalic vein-radial artery side-to-side anastomosis at snuffbox, 46 cases were cephalic vein -radial artery end-to- side anastomosis at proximal wrist, the success cases were 203（94.8% ）, the failed cases were I1 （5.2%）, limb edema in 82 cases and there was no steal syndrome and heart failure. The primary patency rate was 95.2% at 1 year and 91.3% at 2 years. There were 22 patients accepted treatment of arteriovenous fistula occlusion, in which, 8 cases were embolectomy due to acute occlusion, 8 cases were thrombectomy and balloon dilation because of anastomotic stricture and thrombosis and 1 failed, 5 cases were proximal anastomosis again after chronic occlu- sion. Conclusions Autologous arteriovenous fistula of the distal upper limb, especially from the place of snuffbox which is the preferred method for autologous arteriovenous fistula. And deal with arteriovenous fistula occlusion ac- tively can often extend the usage time of the autologous blood vessels and improve the life quality of patients.